What is ERISA and What Does it Mean for You?

In
1974, Congress passed a sweeping piece of legislation known as the Employee
Retirement Income Security Act or “ERISA.” This landmark legislation was designed to
protect retirement and employee welfare plans. Over the past few decades, ERISA
has slowly been used by insurance companies as more of a weapon for avoiding
paying benefits than a protective measure to help employees. To better
understand the key provisions of ERISA and how they apply to you, it’s
important to know what ERISA is and what it generally means for you, as the
American worker.

At
Burke Harvey, LLC, we are devoted to helping clients fight for the benefits
they have earned. If you have been unjustly denied long-term care insurance
benefits, callBurke Harvey, LLC today.

How ERISA Started

Throughout
the first half of the Twentieth Century, companies would routinely withhold
income from paychecks and place it into pensions or employee deferred
compensation plans. Many unions would set up welfare trusts that offered rich
benefits to employees, like health care, dental, retirement, short-term and
long-term disability benefits, and much more. However, employees would work for
decades only to find out the plans were insufficient to pay for retirement, or
they would learn that the company had been mishandling the funds, leaving them
destitute in retirement. This problem needed to be fixed. Hence, Congress
passed ERISA.

Who Does ERISA Cover?

As
of 2013, ERISA covered about 684,000 employer-sponsored retirement plans.
According to theU.S. Department of Labor (DOL),
ERISA also covered approximately 2.4 million health insurance plans and
“welfare benefit plans.” In total, the DOL estimates that ERISA applies to
about 141 million American employees and their beneficiaries.

ERISA
does not cover all health and benefit plans, however. For instance, with a few
exceptions, the following types of organizations are NOT covered by ERISA:

Government employees/agencies

Religious and church organizations

Benefit plans set up only to provide
worker compensation, unemployment, or disability benefits

Excess benefit plans that are not
funded

Non-U.S. benefit plans set up to
benefit non-resident aliens

How to Know if Your Benefits are
Protected by ERISA

If
you want to know if your benefit plans are protected by ERISA, it is pretty
easy to find out. If you are employed by a large corporation with a
self-insured health plan, you are almost certainly covered by ERISA. Likewise,
the majority of large unions will fall under ERISA.

Take
a look at your health plan. If your employer manages the plan and disburses
payments, rather than the health insurance company that sponsors it, you are
likely covered by ERISA.

Ultimately,
you can simply call your plan administrator and ask. Most of your plan
materials should include something explaining how ERISA applies or if your plan
is excluded for some reason.

Key Provisions All Workers Should
Understand

If
covered by ERISA, there are a number of specific provisions that are designed
to protect your rights. These include the following, although this is by no
means an exhaustive list:

Specific fiduciary responsibilities: Those who manage the plan are held
to a fiduciary level of trust. This means they are charged with handling the
plan funds in a responsible manner.

Grievance procedures: The plan must have a specific and
fair way to deal with issues that arise, such as benefit denials and appeals.

Right to sue: If a plan denies benefits and the
employee disagrees, the participating employee can sue the plan for breach of
fiduciary responsibilities.

COBRA Benefits: This benefit allows employees to
continue their health plan after certain life events, including the loss of
employment.

HIPAA: The Health Insurance Portability
and Accountability Act was an amendment that provided a host of protections to
workers with pre-existing conditions.

What Happens if Benefits are
Unjustly Denied?

If
your access to benefits is denied or if the plan administrator unjustly denies
you payments through health or disability plans, you likely will have a short
amount of time within which to bring an appeal. When you and your family are
fighting and struggling to get by, it can be a significant challenge to fight
back against the very company that you depend on for financial support.

Fortunately,
the law provides specific options for disputing benefit denials and fighting
for compensation. Do nott expect it to be easy. Many of these plans are more
than mom and pop shops. They are large, well-funded benefit administrators with
a team of attorneys and accountants working hard to preserve assets. They will
often spend considerable resources to deny benefits to deserving employees. If
you are facing a denial, you deserve a team of aggressive and skilled attorneys
on your side.

At
Burke Harvey, LLC, we have spent decades helping people obtain the benefits
they have worked so hard to earn. Call us today toschedule a free case evaluation,
and find out if we can help you recover your benefits.